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It is seen across a range of peptides and pharmaceutical compounds that carry ionic or charged components, particularly when those compounds are injected into sensitive or low-fat tissue without adequate buffering

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Given the illegal nature of AAS use in many settings and the ethical impossibility of conducting long-term interventional studies with supraphysiological androgen doses in humans, a substantial proportion of cases likely remain unreported, and the true prevalence of this phenomenon may be underestimated in the existing literature

Acknowledgments The authors are thankful to the Ministry of AYUSH under Grant-in-Aid for the Establishment of the Centre of Excellence of Renovation and Upgradation of Patanjali Ayurveda Hospital, Haridwar, India

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